GI exam 3

Question 1

Hiatal Hernia

Answer 1

opening in the diaphragm through
which the esophagus passes becomes enlarged,
and part of the upper stomach tends to move up
into the lower portion of the thorax
- Occurs more often in women than in men

Question 2

Hiatal Hernia s/s

Answer 2

• Mostly asymptomatic
• Heartburn, regurgitation, dysphagia

Question 3

Hiatal Hernia management

Answer 3

• Small, frequent meals
• Do NOT lay flat for 1 hour after meals
• Elevate head of bed
• Surgery (such as fundoplication)

Question 4

Gastroesophageal Reflux
Disease (GERD)

Answer 4

excessive backflow of gastric or
duodenal contents into the esophagus

Question 5

Gastroesophageal Reflux
Disease (GERD) cause

Answer 5

• Can be caused by: incompetent lower esophageal
  sphincter, pyloric stenosis, hiatal hernia, or a motility
  disorder
• Increased risk with older adults

Question 6

Gastroesophageal Reflux
Disease (GERD clinical manifestations

Answer 6

Burning in the esophagus, indigestion, regurgitation,
dysphagia, painful swallowing, hypersalivation,
esophagitis

Question 7

Gastroesophageal Reflux
Disease (GERD) assessment and diagnostics

Answer 7

• Endoscopy or barium
• Ambulatory 12- to 36-hour esophageal pH
  monitoring

Question 8

Gastroesophageal Reflux
Disease (GERD) prevention

Answer 8

• Low-fat diet
• Decreased caffeine, tobacco, beer, milk, peppermint/
  spearmint, carbonated beverages
• Do NOT eat 2 hours before BT
• Weight management

Question 9

Gastroesophageal Reflux
Disease (GERD) management

Answer 9

• Antacids or histamine-2 (H2) receptor antagonists
• Famotidine (Pepcid), nizatidine (Axid), or ranitidine
  (Zantac)
• Proton pump inhibitors
• lansoprazole [Prevacid], rabeprazole [AcipHex],
  esomeprazole [Nexium], omeprazole [Prilosec],
  orpantoprazole [Protonix]
• Prokinetic agents
• bethanechol (Urecholine), domperidone (Motilium), or
  metoclopramide (Reglan)
• Surgery: Nissen fundoplication (if meds don’t work)

Question 10

Nissen Fundoplication

Answer 10

Strengthen the valve between the esophagus and stomach,
which stops acid from backing up into the esophagus as
easily.
-[ Allows the esophagus to heal.
- The surgery can treat GERD and Hiatal hernia that are not
controlled by medications

Question 11

Nissen Fundoplication complications

Answer 11

• Difficulty swallowing because the stomach is wrapped too
  high or tight on the
• The esophagus sliding out of the wrapped portion of the
  stomach
• Heartburn
• Bloating and gas buildup

Question 12

Nissen Fundoplication dietary post op instruction

Answer 12

(avoid stretching of
stomach and gas)
- Eat very slowly, small bites, and chew well.
- Eat small, frequent meals (six to eight per day).
- Avoid drinking large amounts of fluids with meals
(limit fluids to 1/2 cup with meals and one cup with
snacks).
- Sit upright while eating and stay upright for 30
minutes after each meal. Sit upright for 2 hours after
your last meal or snack of the day.
- Avoid crusty breads and sticky, gummy foods, such
as bananas, fresh doughy breads, rolls and
doughnuts. These types of foods become sticky
and difficult to swallow.

Question 13

Nissen Fundoplication dietary post op instruction PART TWO

Answer 13

Avoid sweets to prevent dumping syndrome.
- Rapid emptying of food from stomach to small
intestines
- Can cause symptoms of nausea, weakness, cold
sweats, cramps, diarrhea and dizzy spells.
- Avoid drinking through a straw. Do not chew gum or
tobacco. Chew with mouth closed.
- Avoid any foods that cause stomach gas and
distention such as corn, dried beans, peas, lentils,
onions, broccoli, cauliflower and any food from the
cabbage family.
- Avoid carbonated drinks, alcohol, citrus and tomato products

Question 14

Heartburn

Answer 14

Usually occurs after eating or
while lying down or bending
over.
- Burning sensation in your
chest that may start in your
upper abdomen and radiate all
the way to your neck.
- Odynophagia or painful
swallowing
- Can be brief or continue for a
few hours

Question 15

MI

Answer 15

Sudden pressure, tightening, squeezing
or crushing chest pain
- Pain spreading to the back, neck, jaw,
shoulders or arms — especially the left
arm
- Chest discomfort accompanied by
shortness of breath, sweating, dizziness
or nausea
- Pressure or tightness in the chest
during physical activity or when you’re
under emotional stress
- Feels like heartburn - but different and
accompanied by SOB, dizziness or
chest tightness

Question 16

Gastritis

Answer 16

 Characterized by inflammation of the gastric
mucosa
 Common in older adults
 Can be acute– lasting several hours to few days
 Can be chronic– as a result of repeated gastritis or
irritation
 May lead to hemorrhage or perforation
 Can be caused by H.pylori (non-erosive) or long term
intake of NSAIDs, alcohol, or radiation (erosive)

Question 17

Gastritis clinical manifestations

Answer 17

Rapid onset of abdominal discomfort, headache,
exhaustion, nausea, anorexia, vomiting, hiccups,
sour taste
 Pain can be relieved by eating
 Erosive gastritis may lead to bleeding
 Vomiting blood or black tarry stools

Question 18

gastritis Assessment and Diagnostics

Answer 18

 History and physical assessment
 Endoscopy
 Assessment for presence of H.pylori

Question 19

Gastritis management

Answer 19

 May heal on its own in 1-3 days
 Non-irritating diet as tolerated
 Avoid food until relief of symptoms
 IV fluids
 In case of bleeding, control it
 NG tube
 Medications: antacids, H2 blockers, proton pump inhibitors
 Teach patient to modify diet, rest, stress management,
avoid alcohol, avoid NSAIDs
 Treat H.pylori

Question 20

Peptic Ulcer Disease
(PUD)

Answer 20

 Can be gastric, duodenal, or esophageal ulcer
 May be precipitated by GERD or chronic gastritis
 Can be caused by H.pylori, NSAIDs, excessive
secretion of HCl
 Family history and chronic illnesses/ stress (i.e.,
hospitalization, COPD, CKD, burns…) play a role
 May last few days, weeks or months

Question 21

Peptic Ulcer Disease clinical manifestations

Answer 21

 Many people are asymptomatic
 Dull gnawing pain, burning sensation in min-epigastric
area or back, epigastric tenderness, abdominal distention
 Heartburn, vomiting, constipation or diarrhea, bleeding
 Gastric ulcer: pain after eating
 Duodenal ulcer: pain 2-3 hours after eating, relief of pain
after eating. awakened by pain at night more

Question 22

Peptic Ulcer Disease assessment and diagnostics

Answer 22

Detailed assessment and history
 Endoscopy, biopsy to test for H.pylori

Question 23

Peptic Ulcer Disease medical management

Answer 23

antibiotics (for H.pylori), proton
pump inhibitors, bismuth salts (Pepto-Bismol) (treat
H.pylori)
 Treatment duration 10-14 days
 H2blockers (in absence of H.pyori)
 Avoid NSAIDs
 Compliance with medical management is essential!
 Smoking cessation
 Dietary modification: avoid too hot or too cold food, no
alcohol, no coffee, no caffeinated beverages, small
frequent meals
 Surgery (when treatment fails)

Question 24

Obesity

Answer 24

 Characterized as a metabolic disease due to accumulation of fat in a
manner that impairs health
 Overweight: body mass index (BMI) of 25 to 29.9 kg/m2, and obese:
BMI exceeds 30 kg/m2
 Affects mortality and morbidity; it is a health risk
 May also lead to low self esteem, impaired body image, depression,
decreased QOL

Question 25

Gastric Cancer

Answer 25

Incidence is decreasing and men are at higher risk  Prognosis is usually poor  Risk increases with diet high in smoked, salted, or pickled foods and low in fruits and vegetables  Other risk factors include:  Chronic inflammation of the stomach, H. pylori infection, pernicious anemia, smoking, gastric ulcers, previous subtotal gastrectomy, and genetics

Question 26

gastric cancer clinical manifestations

Answer 26

 Pain relieved by antacids (early sign),  Dyspepsia (indigestion), early satiety  Weight loss, abdominal pain just above the umbilicus  Loss or decrease in appetite, bloating after meals  Nausea and vomiting  Symptoms similar to those of peptic ulcer disease

Question 27

gastric cancer medical management

Answer 27

 Diagnostic laparoscopy  Total gastrectomy, radical subtotalgastrectomy  Chemotherapy

Question 28

Functions of the liver

Answer 28

 Glucose metabolism– stored as glycogen  Ammonia conversion  Protein metabolism– blood protein that help in clotting, oxygen transport, and immune system  Fat metabolism  Vitamin and iron storage  Bile formation– help digestion  Bilirubin excretion  Drug metabolism (and alcohol)

Question 29

Age-related Changes of the Hepatobiliary system

Answer 29

 Steady decrease in size and weight of the liver, particularly in women  Decrease in blood flow  Decrease in replacement/repair of liver cells after injury  Reduced drug metabolism, decline in drug clearance capability  Slow clearance of hepatitis B surface antigen  More rapid progression of hepatitis C infection and lower response rate to therapy  Increased prevalence of gallstones  Decreased gallbladder contraction after a meal  Atypical clinical presentation of biliary disease  More severe complications of biliary tract disease

Question 30

Assessment of Liver

Answer 30

 Hepatotoxic substances or infections  Occupation, recreation, travel  Alcohol and substance abuse  Medication history including prescription, over-the- counter, herbal, dietary supplements  Medical history (previous and current)  Family history  Symptoms that are suggestive of liver disease

Question 31

Physical Assessment of Liver

Answer 31

Pallor, jaundice (skin, mucosa, sclerae)  Muscle atrophy, edema, skin excoriation of extremities  Ecchymosis, spider angiomas, palmar erythema  Gynecomastia and testicular atrophy (male)  Altered mental status: memory, recall, abstract thinking  General tremors, weakness, slurred speech  Ascites  Enlarged liver, tenderness

Question 32

Liver function tests

Answer 32

 Alanine aminotransferase (ALT): liver disease such as hepatitis, cirrhosis  Aspartate aminotransferase (AST): heart, liver, skeletal muscle, and kidney muscle damage  Gamma-glutamyl transferase (GGT): alcohol liver  Serum bilirubin (direct and total), urine bilirubin, fecal bilirubin  Total serum protein, albumin, ammonia  Alkaline phosphatase, PT, cholesterol Liver Biopsy CT, ultrasound, MRI, laparoscopy

Question 33

Manifestation of Liver Disease

Answer 33

 Jaundice  Increased bilirubin concentration  Yellow tinged skin and sclerae  Due to liver disease, obstructive bile flow, excessive destruction of RBCs  Portal HTN (ascites, esophageal varices)– splenomegaly  Ascites  Esophageal varices  Hepatic encephalopathy and coma  Edema and bleeding, pruritis and skin conditions  Vitamin deficiency, metabolic abnormalities (glucose, androgen, sex hormones)

Question 34

Portal HTN

Answer 34

Increased pressure throughout the portal venous system  Results from obstruction of blood flow into and through the damaged liver.  Commonly associated with liver cirrhosis and other, it liver disease.  Splenomegaly (enlarged spleen) is a common manifestation of portal HTN.  Common consequences: ascites and varices.

Question 35

Ascites Contributing factors

Answer 35

 Portal HTN, increased capillary pressure, and obstruction of venous blood flow through the liver  Decreased metabolism of aldosterone, Na and water retention  Albumin rich fluids accumulate in the abdomen

Question 36

Ascites Clinical manifestation

Answer 36

Increased abdominal girth, weight gain, SOB, enlarged abdomen, striae (abd. area)

Question 37

Ascites Medical management

Answer 37

Nutrition therapy: Low Na  Medications: diuretics, spirinolactone, furosemide-- electrolyte balance  Bed rest, daily weight  Paracentesis– empty fluids through catheter in abd.– supplement albumin IV  Other therapies– peritoneovenous shunt

Question 38

Esophageal Varices Contributing factors

Answer 38

Varicosities that develop from elevated pressure in the veins that drain into the portal system.  Prone to rupture and often are the source of massive hemorrhages from the upper GI tract and the rectum.

Question 39

Esophageal Varices Clinical manifestations

Answer 39

Hematemesis, melena, change in mental status  Shock symptoms (cool clammy skin, hypotension, tachycardia)  Alcohol abuse

Question 40

Esophageal Varices assessment

Answer 40

Endoscopy– cause of bleeding  Labs: liver function test

Question 41

Esophageal Varices medical management

Answer 41

 Medications  Octreotide (Sandostatin)– immediate decrease bleeding  Vasopressin– urgent vasoconstiction and decrease portal pressure  Contraindicated with CAD; nitroglycerine added  Betablockers– decrease portal pressure  Balloon tamponade– control hemorrhage  Endoscopic sclerotherapy– thrombosis and eventual sclerosis  Endoscopic variceal ligation  Transjugular Intrahepatic Portosystemic Shunt (TIPS)  Surgery– bypass surgeries

Question 42

Hepatic Encephalopathy

Answer 42

Neuropsychiatric manifestation of liver failure associated with portal hypertension and the shunting of blood from the portal venous system into the systemic circulation.  The onset is often insidious and it is often a life threatening complication

Question 43

Hepatic Encephalopathy causes

Answer 43

Hepatic insufficiency as a result of the inability detoxify metabolism byproducts  Portosystem shunting  Ammonia is a major factor– enters the brain, excites peripheral benzodiazepine-type receptors– increase nonsteroidal synthesis and stimulate GABA neurotransmission  Ammonia increases with GI bleeding and ingestion of protein  Other causes: diuresis, dehydration, infections surgery, fever, and some medications

Question 44

Hepatic Encephalopathy clinical manifestations

Answer 44

Mental status changes and motor disturbances  Confusion, altered mood and sleep  Restlessness, frequent naps during the day, insomnia at night  Asterixis (“liver flap”)– Figure 43-12– difficulty writing or drawing  Hyperactive deep tendon reflexes,  Ends up in disorientation, coma, seizures, diminished reflexes and flaccid reflexes

Question 45

Hepatic Encephalopathy Assessment and Diagnostics

Answer 45

EEG

Question 46

Hepatic Encephalopathy medical management

Answer 46

Eliminate the cause, decrease ammonia levels  Minimize complications of cirrhosis and dec LOC  Reverse bleeding, electrolyte imbalance, sedation, or azotemia (inc BUN, inc Cr)

Question 47

Hepatic Encephalopathy Pharmacotherapy

Answer 47

Administer Lactulose to decrease serum ammonia levels  Monitor hypokalemia and dehydration with diarrhea  Glucose IV to dec protein breakdown  Correct electrolytes  Neomycin, metronidazole, rifaximin to dec effects of ammonia forming bacteria

Question 48

Hepatic Encephalopathy nursing care and management

Answer 48

 Neurologic assessment and mental status frequently  Acc I/O, body weight daily, monitor for hypovolemia  V/S every 4 hours  Prevent and assess for potential infections (peritoneum and lungs)  Monitor serum ammonia daily  Restrict protein intake and enteral feeding if needed  Decreased ammonia absorption in GI (gastric suction, enema, antibiotics)  Electrolytes– monitor and correct  Prevent injuries and bleeding  Monitor respiratory status and prevent complcations: pneumonia & atelactasis & depression  Prevent pressure ulcers, falls, ADLs

Question 49

Viral Hepatitis

Answer 49

Systemic viral infection causing necrosis and inflammation of liver cells  5 types: A, B, C, D, E  A, E– oral-fecal route  Easy transmission with high morbidity

Question 50

Hepatitis A

Answer 50

 20-25% of cases and seen in adult populations  Transmitted through oral- fecal route, ingestion of food or fluids with the virus, sexual routes  Prevalent in countries with poor sanitation  Incubation: 2- 4 weeks  Liver and spleen enlarged for a few days after onset  Hepatitis A antigen found in stool 7-10 days before illness and for 2-3 weeks after symptoms  Symptoms clear in 10 days

Question 51

Hepatitis A Clinical manifestations

Answer 51

Asymptomatic  Mild, flu-like symptoms– URTI, mild fever  (Later) anorexia, jaundice, dark urine, indigestion  Aversion to cigarettes and cigarette smoke and other odors

Question 52

Hepatitis A Prevention

Answer 52

Encourage proper community and home sanitation; individual hygiene.  Educate patients regarding safe practices for preparing and dispensing food.  Support effective health supervision of schools, dormitories, extended care facilities, barracks, and camps.  Facilitate mandatory reporting of viral hepatitis to local health departments.  Recommend vaccination for travelers to developing countries, illegal drug users MSM, people with chronic liver disease, and recipients of pooled plasma products. - vaccination

Question 53

Hepatitis A medical management

Answer 53

Bed rest  Nutritious diet, IV fluids (during anorexia

Question 54

Hepatitis A nursing care

Answer 54

Manage fatigue, rest  Patient and family education  Seek healthcare in case symptoms worsen  Diet, avoid alcohol  Blood work

Question 55

Hepatitis B

Answer 55

Transmitted by blood primarily; can be found in blood, saliva, semen, vaginal secretions  Long incubation period: 1-6 months  Many HBV infected recover within 6 mo. Others develop a chronic HBV infection and hepatocellular carcinoma

Question 56

Hepatitis B risk factors

Answer 56

Exposure to blood, blood product, body fluids  Healthcare workers, hemodialysis  MSM, bisexual activity, multiple partners, IV drug users  Mom-child transmission  Tattooing  Receipt of blood

Question 57

Hepatitis B prevention

Answer 57

 Vaccination to limit outbreaks  Vaccination for persons at risk for infection by sexual exposure, by percutaneous or mucosal exposure to blood.  Vaccination for international travelers and for persons with chronic liver disease or with human immunodeficiency virus infection.  Vaccination of all infants

Question 58

Hepatitis B clinical manifestations

Answer 58

Insidious and variable onset of signs and symptoms  Fever and respiratory symptoms are rare  Loss of appetite, dyspepsia, abdominal pain, weakness, generalized aching and malaise  Jaundice may not develop. In case of jaundice, light colored stool and dark urine occur too  Enlarged spleen, enlarged cervical lymph nodes  HBV surface antigen is detected in blood in 1-10 weeks

Question 59

Hepatitis B management

Answer 59

 Goal: minimize infectivity, minimize liver inflammation, and decrease symptoms  Alpha-interferon IV 3x/week for 16 to 24 weeks  Lots of side effects  Anti-viral agents: Lamivudine (Epivir) and adefovir (Hepsera)  Bed rest, restrict activity  Adequate nutrition, fluids  Symptom control (nausea, vomiting)  Avoid sexual contact

Question 60

Hepatitis C

Answer 60

Blood transfusion and sexual contact transmission  Most common, with high prevalence  Incubation is variable: 5- 160 days  Similar clinical course to HBV  Chronic carrier state is common  HCV with alcohol and medications affect liver No benefit from rest, diet or vitamin supplements

Question 61

Hepatitis C risk factors

Answer 61

Recipient of blood products or organ transplant before 1992 or clotting factor concentrates before 1987  Health care and public safety workers after needlestick injuries or mucosal exposure to blood  Children born to women infected with hepatitis C virus  Past/current illicit IV/injection drug use  Multiple contacts with a hepatitis C virus–infected person  Multiple sex partners, history of sexually transmitted infection, unprotected sex

Question 62

Medications to treat relapse hep c

Answer 62

Peginterferon and ribavirin  Telaprevir and boceprevir

Question 63

NonViral Hepatitis

Answer 63

Toxic Hepatitis and Drug Induced Hepatitis

Question 64

Toxic Hepatitis

Answer 64

History of exposure to hepatotoxic chemicals, medications.

Question 65

Drug Induced Hepatitis

Answer 65

Most common cause of acute liver failure  Sensitivity to medication; most common cause: acetaminophen  Abrupt onset: chills, fever, rash, pruritis, arthralgia, anorexia, vomiting, jaundice, dark urine, enlarged/ tender liver

Question 66

Liver Cirrhosis

Answer 66

Liver tissue is replaced by diffuse fibrosis/ scar tissue thus resulting on disruption of the structure and function of the liver

Question 67

3 types of liver cirrhosis

Answer 67

Alcoholic cirrhosis  Postnecrotic cirrhosis  Biliary cirrhosis

Question 68

Liver Cirrhosis prevention

Answer 68

 Avoid alcohol abuse  Avoid high risk sexual behaviors, unprotected sex and multiple partners  Be careful around chemicals  Use medications as prescribed  Get Hepatitis B vaccine  Diet: low fat high in fruits and vegetables  Maintain healthy weight

Question 69

Liver Cirrhosis causes

Answer 69

Alcohol intake is a major factor causing fatty liver  Nutrition deficiency and decreased protein intake contributes to liver destruction in cirrhosis  Chemical exposure or infections  Fatty liver due to obesity and diabetes  Chronic viral infection of the liver (i.e., Hepatitis B, C, D)  Obstruction of biliary duct  Complication of heart failure

Question 70

Clinical manifestation cirrhosis

Answer 70

Depends on severity of cirrhosis– compensated (less severe; vague symptoms) or decompensated (failure to synthesize proteins, clotting factors & other substances, portal HTN)

Question 71

Liver Cirrhosis Compensated

Answer 71

Intermittent mild fever  Vascular spiders  Reddened palms  Unexplained epistaxis  Ankle edema  Vague morning indigestion  Flatulent dyspepsia  Abdominal pain  Firm, enlarged liver

Question 72

Decompensated

Answer 72

 Ascites  Jaundice, grey colored stools  Weakness, fatigue  Muscle wasting  Weight loss, loss of appetite  Continuous mild fever  Clubbing of fingers  Purpura, itchy skin  Spontaneous bruising  Epistaxis  Hypotension  Sparse body hair  White nails  Gonadal atrophy

Question 73

Liver enlargement cirrhosis

Answer 73

Large liver and cells are loaded with fat– early sign  Firm liver with sharp edges  Abdominal pain– rapid enlargement of liver

Question 74

Portal obstruction and ascites cirrhosis

Answer 74

Late manifestation due to chronic liver failure  Blood from GI goes to portal vein and to liver  Cirrhotic liver limits blood flow into liver; thus blood backs up in spleen and GI tract– indigestion, ascites, splenomegaly, esophageal varices and bleeding

Question 75

Infection and peritonitis cirhosis

Answer 75

Spontaneous bacterial peritonitis– antibiotics  May lead to hepatorenal syndrome– renal failure without any reason related to kidney

Question 76

GI Varices liver cirrhosis

Answer 76

Due to decreased circulation into liver and portal HTN– collateral blood vessels in GI system develop especially esophagus, stomach, rectum

Question 77

treatment gi varices

Answer 77

band ligation (stop bleeding) or TIPS (transjugular intrahepatic portosystemic shunt

Question 78

Liver Cirrhosis  Edema

Answer 78

Late symptom due to decreased plasma albumin concentration  Mainly in LE and UE with overproduction of aldosterone (Na and water retention and K excretion)

Question 79

vitamin deficiency cirrhosis

Answer 79

Vitamin K deficiency– hemorrhagic phenomena  Anemia, poor nutrition, fatigue, decreased ability to perform ADLs

Question 80

Mental deterioration liver cirrhosis

Answer 80

Decreased mental and cognitive function– hepatic encephalopathy and coma  Changes in patient’s general behavior, cognitive abilities, orientation to time and place, and altered speech patterns

Question 81

Liver Cirrhosis  Assessment and Diagnostics

Answer 81

Assess for clinical manifestations  Palpation of the liver  Serum albumin (low)  Bilirubin (high)  Serum globulin (high)  Liver enzymes, AST, ALT, GGT (high)  Serum cholinesterase (lwo)  Prothrombin time (high)  US, CT, MRI, liver biopsy, radioisotope liver/ spleen...

Question 82

Liver Cirrhosis  Medical management (based on symptoms)

Answer 82

Avoid alcohol. STOP drinking!  Avoid or stop medications that cause liver injury (steroids, anti-viral drugs, acetaminophen, ibuprofen...)  Antacid and H2 antagonist– minimize GI symptoms & bleeding  Vitamins and nutritional supplement– heal liver cells  K-sparing diuretics (spirinolactone)– decrease ascites  Correct electrolytes  Lactulose– encephalopathy  No cure! Treatment stops or delays progress of the disease, minimizes damage, and prevents complications.

Question 83

Liver Cirrhosis  Ascites

Answer 83

 Low sodium diet  Diuretics  Paracentesis  TIPS

Question 84

Bleeding GI varices cirrhosis

Answer 84

Betablockers for vasoconstriction  Shunts– TIPS and/ or endoscopic variceal banding

Question 85

Changes in mental status– encephalopathy cirrhosis

Answer 85

Low protein diet  Lactulose  Avoid sedatives– sleeping pills, antianxiety, narcotics

Question 86

Complications of liver cirrhosis

Answer 86

Kidney failure  Decreased oxygen in blood  Diabetes  Altered blood and electrolyte counts  Increased risk of infections  Increased bleeding and bruising  Loss of muscle mass  Men: breast enlargement, women: early menopause Once management of these complications fails, liver transplant is recommended

Question 87

Nursing care of patient with liver cirrhosis

Answer 87

Promote rest  Daily weight and I&O  Assess oxygenation and resp. status; oxygen therapy  Enhance nutritional status  Without ascites, edema, encephalopathy: high protein with Vit. A, B complex, C, K  With ascites: small, frequent meals, low Na  With fatty stool: water soluble forms of Vit A, D, E  With encephalopathy: low protein  Folic acid– anemia  Skin care, prevent infections, prevent pressure ulcers  Reduce risk for injury– bleeding risk and altered LOC

Question 88

Nursing care of patient with liver cirrhosis part 2

Answer 88

 Monitoring and managing potential complications  Bleeding and hemorrhage  Hepatic encephalopathy  Assess mental status and dementia; voluntary and involuntary movement  Fluid and volume excess  Pulmonary complications, ascites, cardiovascular complications  Fluid restriction, Acc I&O, weight daily, abdominal girth  Patient and family education

Question 89

dumping syndrome s/s

Answer 89

sweating, dizziness, nausea, cramps, diarrhea

Question 90

h pylori treatment

Answer 90

abx for 10-14 days - amox - pepto - flagell - clarithromicin - ppis